Referral patterns and adjuvant chemotherapy use in patients with stage II colon cancer.

BACKGROUND: Little is known about the actual rate of use of adjuvant chemotherapy in stage II colon cancer and about referral patterns that give patients access to this treatment. PATIENTS AND METHODS: We searched the tumor registry at Baylor University Medical Center at Dallas to identify patients with stage II colon cancer who underwent resection between 1995 and 2003. The rates of referral to medical oncology and adjuvant chemotherapy use were calculated and potential predictive variables were analyzed using univariate and multivariate techniques. RESULTS: We identified 287 patients with stage II colon cancer. A total of 160 patients (56%) were referred to a medical oncologist. Eighty patients (28%) received adjuvant chemotherapy. Age < 50 years, private insurance status, lower comorbidity score, higher T stage, and poor tumor differentiation were significant predictors of adjuvant chemotherapy use (P

Increased anion gap metabolic acidosis as a result of 5-oxoproline (pyroglutamic acid): a role for acetaminophen.

The endogenous organic acid metabolic acidoses that occur commonly in adults include lactic acidosis; ketoacidosis; acidosis that results from the ingestion of toxic substances such as methanol, ethylene glycol, or paraldehyde; and a component of the acidosis of kidney failure. Another rare but underdiagnosed cause of severe, high anion gap metabolic acidosis in adults is that due to accumulation of 5-oxoproline (pyroglutamic acid). Reported are four patients with this syndrome, and reviewed are 18 adult patients who were reported previously in the literature. Twenty-one patients had major exposure to acetaminophen (one only acute exposure). Eighteen (82%) of the 22 patients were women. Most of the patients were malnourished as a result of multiple medical comorbidities, and most had some degree of kidney dysfunction or overt failure. The chronic ingestion of acetaminophen, especially by malnourished women, may generate high anion gap metabolic acidosis. This undoubtedly is an underdiagnosed condition because measurements of serum and/or urinary 5-oxoproline levels are not readily available.